A provision in HB1638 requires insurers to cover prescribed drugs immediately during appeals—and it's likely to increase what your business pays for employee health insurance.
Most auto service owners in New Hampshire don't realize that a health insurance provision buried in HB1638 could directly affect what they pay for employee coverage. The bill, which creates a bypass mechanism for health insurer step-therapy protocols, contains a mandate that will likely raise premiums for small businesses that self-insure or buy fully-insured group health plans.
Step therapy is a common insurance practice: when a doctor prescribes a medication, the insurer requires the patient to try a cheaper drug first. If that doesn't work, the patient can appeal for coverage of the prescribed drug.
Under the new provision in HB1638 (codified in RSA 420-J:32, VI, found on pages 5–6 of the bill), insurers must now cover the prescribed drug while the appeal is pending. Additionally, if an insurer misses the deadline to respond to an appeal, the exception is automatically granted—meaning the drug gets covered without further review.
This sounds straightforward from a patient perspective. But for business owners, it has a direct cost consequence.
When insurers are required to cover more drugs immediately—and to auto-grant exceptions on missed deadlines—their claim costs rise. Those increased costs flow directly into the premiums that employers pay. The fiscal note accompanying HB1638 confirms this: premiums are expected to rise as a result of this mandate.
If your auto service business offers a group health plan to employees, whether you self-insure or purchase coverage from a carrier, you will absorb these higher costs through increased premiums or claims expenses. For a small business with tight margins, even a modest premium increase can affect hiring, wages, or reinvestment decisions.
This provision applies to:
If you don't offer health insurance, this provision does not directly affect you. If you do, you should expect to see it reflected in renewal notices or rate adjustments.
The provision becomes effective 90 days after HB1638 is signed into law. Insurers will be required to comply with the step-therapy bypass rules and the immediate-coverage mandate starting on that date.
Review your current health plan renewal cycle and ask your broker or carrier how this provision will affect your rates. If you're approaching renewal, the timing of when the law takes effect may matter for your renewal date. Document your current premium and claims experience so you can track the impact over time.
For a more detailed, business-specific breakdown of how HB1638 affects auto service employers, a free resource is available through trade associations and local business advisors familiar with New Hampshire employment law.
Source: HB1638, Section 1, RSA 420-J:32, VI; New Hampshire Legislature fiscal note.